With growing evidence base for Regenerative therapies today. Standard treatment options in orthopedics and sports medicine are replaced by Regenerative Medicine Interventions for common Orthopedic, Spine and Sports medicine conditions. We at Cornell Pain Clinic are proud to offer Regenerative Medicine therapies like Platelet Rich Plasma (PRP) and Mesenchymal Stem cell therapy.

It is estimated that around 1 in 3 people in united states can benefit from some type of Regenerative Therapies

Stem Cell Therapy

There are two main sources of Stem cells: Embryonic Stem cells and Adult body tissues

Embryonic Stem Cells

At a very early stage of pregnancy, when sperm fertilizes an egg this leads to embryo formation.

Around 3 to 5 days after a sperm fertilizes an egg, the embryo takes the form of Blastocyst or ball of cells

This blastocyst, cell mass of 150-200 cells just before implantation into uterus or womb consist of two parts

• Inner cell mass: that will develop into full human body
• Outer cell mass: that will become part of placenta

Inner cell mass is where Embryonic stem cells are found, scientists call these cells as Totipotent cells. Totipotent cells refer to the fact that these cells have total potential to develop into any cell in the body.

Most of embryonic stem cells are derived from embryos that develop from egg fertilized in – vitro in an In-Vitro fertilization clinic- and then donated for research purposes with informed consent of donors. They are not derived from eggs fertilized in women’s body. Use of embryonic tissue for Stem cell therapy comes with its own problems such as ethical issues, legal issues, and uncontrolled growth leading to  tumor causing potential of embryonic cells.

Adult Stem Cells

A person’s body contains stem cells throughout their life. The body can use these stem cells to repair or heal itself whenever needed.

Adult stem cells are also called tissue-specific or somatic stem cells, they exist throughout the body from the time an embryo develops to adult human being.

These adult stem cells have limited potential of growing into tissue specific cells, unlike embryonic stem cells which can grow into any cell or tissue of our body. They remain in their own tissue state until the body needs them for a specific purpose, such as skin or intestinal lining cells.

During normal everyday life, our body is constantly renewing its tissues. In some parts of the body, such as the stomach linings and bone marrow- stem cells regularly divide to produce new body cells and tissues for maintenance and repair.

Stem cells are present inside various types of tissues. Scientists have found stem cells more commonly in tissues, including:

• the brain
• bone marrow
• Adipose tissue( fat )
• the liver
• blood and blood vessels
• skeletal muscles
• skin

However, stem cells can be difficult to isolate from normal cells from our body. They can stay non-dividing and non-specific for years until the body summons them to repair or grow new tissue.

Adult stem cells can divide or self-renew indefinitely. This means they can generate various cell types from the originating organ or even regenerate the original organ, entirely.

This division and regeneration is underlying mechanism how a skin wound heals, or how an organ such as the liver, can repair and regrow itself after damage.

In the past, scientists believed adult stem cells could only differentiate based on their tissue of origin. However, some evidence now suggests that they can differentiate to become other cell types as well, known as Multipotent Stem cells.

It is the process of replacing, regenerating cells, tissues or organ to restore normal function. The body has a remarkable natural ability to heal itself. By facilitating or accelerating this process, we can initiate or support a healing process naturally, which routinely requires surgery. Examples of this injuries include menisci tears at knee Joint and rotator cuff tears at Shoulder joint.

Regenerative therapies, including platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) have gained popularity in recent years after many sports related injures by famous sports athletes are treated by PRP or Stem cell therapy instead of traditional surgical methods for better long term outcomes. Some of these famous athletes are

Tiger woods, Rafael Nadal, Dwight Howard, Kobe Bryant, Bartolo Colon, Stephen curry and many more.

Although gaining popularity in recent years, PRP was fist developed in 1970s, and its first documented use was for cardiac surgery in 1987 and thereafter it was successfully used to significantly improve healing in facial, dental, cosmetic procedures.

With ongoing research and evidence, field of Regenerative medicine has also evolved. Current evidence shows promising use of PRP and Mesenchymal Stem Cell Therapy.

• Prolotherapy:

It is also called “proliferative therapy”, which is performed by injecting irritant solutions that stimulate low-grade inflammatory reaction to promote tissue proliferation and healing. Many irritant solutions have been used but Hyperosmolar dextrose is most commonly used.

• Stromal vascular Fraction (SVF):

It is concentrated solution of Adipose (fat) derived stem cells, along with host of growth factors. It is derived by liposuction or lipoaspiration and separating different components of fat and vascular tissue.

• Platelet rich Plasma (PRP):

Platelets are known to play integral role in blood clotting and our healing process by secreting multitude of growth factors after any tissue injury. PRP is a solution containing concentrated high number of platelets than our normal blood and growth factors. It is derived from whole blood by a density gradient centrifugation process where plasma rich in platelet is separated out and injected at injured site for healing.

• Stem Cell Therapy; Mesenchymal Stem Cells (MSCs): 

Cells in the body have specific purposes, but stem cells are cells that do not yet have a specific role and can become almost any cell that is required.

Stem cells are undifferentiated cells that can turn into specific cells, as the body needs them. Theoretically Stem cell has unlimited potential to get differentiated into any type of cell, tissue or organ based on environmental cues.

What is PRP?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red blood cells, white blood cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of important growth factors which are very important in the healing from injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 4 to 8 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation.

Platelet rich plasma is a biological means of stimulating wound healing and tissue regeneration.

First developed in 1970s, it has been used over last 40 years to improve healing in dental, cosmetic, facial procedures and increasingly used over last decade for Orthopedic conditions and during surgeries.

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Why platelets?

Platelets are important component of our blood to aggregate and aiding blood clot formation after any injury. They also release more than 30 bioactive proteins( growth factors) that initiate hemostasis and regulate healing.

Platelet contains numerous growth factor proteins stored inside themselves like

• Platelet derived growth factor (PGDF)
• Vascular endothelial growth factor (VEGF)
• Epidermal growth factor (EGF)
• Fibroblast growth factor (FGF)
• Transforming growth factor (TGF)

These growth factors released from platelets promote tissue healing in different phases by

1. Stimulating cell replication
2. Promote angiogenesis (blood vessel formation)
3. Promote tissue granulation formation( vascular tissue regrowth)
4. Promote growth of extracellular matrix( supporting tissue)

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How does healing occur?

Regenerative therapy like PRP works by supportive or stimulating your natural healing mechanism, just like you experience after a injury. This healing occurs in 3 different phases

Phase 1: Inflammation: During which you may experience increase pain, and its important not to inhibit this phase of healing by steroids or Anti-inflammatory medications. Hence you are advised to stop taking Ibuprofen, Alleve which prevents this important part of our healing process.

Phase 2: Cell proliferation and matrix deposition: Tranforming growth factor( TGF) and many other growth factors stimulate cellular growth and deposition of stroma( supporting tissue)

Phase 3: Matrix Remodeling: matrix metalloproteinases and other scavenger cells act as a cleaning crew and remove debris and excess of tissue during the healing process.

You may hear the term “mesenchymal stem cell” or MSC to refer to cells isolated from stroma, the connective tissue that surrounds other tissues and organs. These cells are more accurately called “stromal cells” by many scientists.

The first MSCs were discovered in the bone marrow and were shown to be capable of making bone, cartilage and fat cells. Since then, they have been grown from other tissues, such as fat and cord blood.

Mesenchymal stem cells (MSCs) can make several types of cells belonging to our skeletal tissues, such as cartilage, bone and fat. Scientists and practitioners have gathered enough evidence to use MSCs for treating bone and cartilage diseases.

Various MSCs are being tested and researched as treatments for a great many disorders, but there is little evidence to date that they are beneficial in diseases such as Autism, Parkinson’s, Macular degeneration and many other Neurodegenerative disorders.

Coming from different areas of body, Researchers believe that not all MSCs are the same, and that their characteristics depend on where in the body they come from and how they are isolated and grown.

What do we know?

Mesenchymal stem cells (MSCs) are multipotent stem cells found in bone marrow that are important for making and repairing skeletal tissues, such as cartilage, bone and the fat found in bone marrow. These are not to be confused with hematopoietic (blood) stem cells that are also found in bone marrow and make our blood.

MSCs make up a very small fraction of all the cells in our bone marrow, but through studies and research we have been able to isolate MSCs so they can be used for treatment for common orthopedic, spine and musculoskeletal conditions.

MSCs are important for creating a niche environment or ‘home’ for blood stem cells in bone marrow.

Scientific Evidence for Mesenchymal Stem cell treatment?

Advances in scientific understanding of degenerative cellular and connective tissue process; lack of long-term efficacy of steroid injection therapies has prompted the need for alternative therapies.

PRP and Mesenchymal stem cell therapy have been used as both principal treatment and augmentative therapy alongside surgical repair.

Good quality evidence is still to come for many disorders. In Sports Medicine, Orthopedic and spine disorders; there is growing evidence for following conditions

TENDINOPATHIES

• Lateral Epicondyle Tendinopathy
• Achilles Tendinopathy
• Patellar Tendinopathy
• Rotator Cuff Tendinopathy
• Plantar fascia Aponeurosis Pain
• Greater Trochanteric Pain/ Gluteus Medius Tendinopathy

LIGAMENT INJURIES

• Anterior Cruciate Ligament( ACL of knee joint)
• Ulner Collateral Ligament of the Elbow

CARTILAGE INJURY/ TEARS

• Knee Osteoarthritis: Several study trials has shown promising results for Mild to Moderate Osteoarthritis.
• Meniscus Injury( Knee): Few studies showing benefit of PRP or MSC therapy

DEGENERATIVE DISC DISEASE ( DDD)

• Few studies showing promising benefit to treat Discogenic low back pain

CONCLUSION: Research on PRP and Stem cell therapy continues to advance. Presently there is moderate quality evidence for Regenerative therapies for Lateral Epicondylitis and Knee Osteoarthritis. Early results indicate potential for treating discogenic pain. It may help for ankle and hip Osteoarthritis, patellar, and Achilles tendinopathy, Injury of the UCL of the elbow, ankle ligaments, and medial meniscus.

Use of PRP and Autologous (your own) Bone marrow stem cell use has been used over last 40 years with minimal harm.

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Safety and Controversy related to Stem Cell therapy

Despite the huge excitement among researchers about magical potential of stem cells; there is also controversy about stem cell research and concern about safety of using unproven stem cell therapy. This controversy is mainly related to embryonic stem cells.

Embryonic stem cell use: There is ethical debate against using embryonic stem cells as it destroys the fertilized egg, which would have developed to human baby.

Stem cell therapy and FDA: Many centers and clinics are providing Stem cell treatment for variety of conditions, many of these therapies are not yet U.S. Food and Drug Administration (FDA) approved which means their safety for public use has not been established.

Use of PRP and Autologous (your own) Bone marrow stem cell use has been used over last 40 years with minimal harm.

ELBOW PAIN

Elbow pain is frequently seen in those who are actively involved in tennis, golf or baseball. Repetitive motion of the wrist and arm for these activities can lead to tendon strain, microscopic tears and persistent inflammation of the tendons involved in those movements. Osteoarthritis is another common condition that can cause chronic elbow pain and inflammation.

Lateral Epicondylitis or Tennis Elbow is a type of tendinitis (inflammation of tendon) that causes pain around your elbow and arm. These tendons are tough tissue that connect muscles of your lower arm to the bone (epicondyle). You can still get tennis elbow if you never played sports but instead involved in repetitive gripping and twisting movements from your hands.

Many people experiencing above symptoms from common injuries are excellent candidate for stem cell therapy. Many professional pitchers are able to avoid invasive surgery through stem cell therapy.

First hand conservative treatment for elbow pain is to rest the arm and trying over-the-counter pain medications like ibuprofen, to allow the body to heal. More involved treatment options for severe cases range from steroid injections, tendon debridement, and surgical release.

 SHOULDER INJURIES AND PAIN

Shoulder pain is a very common complaint. Unfortunately, shoulder surgery can be difficult due to the complexity of the joint and has poorest post-surgery outcome data unlike any other joint in our body.

Individuals suffering from shoulder pain due to common injuries of the rotator cuff and shoulder labrum, as well as those facing shoulder replacement due to arthritis and other degenerative problems may be excellent candidates for regenerative therapy.

Initial first line treatment for shoulder injuries is to rest the shoulder, trying over the counter pain medications and physical rehab. More involved options range from intraarticular steroid injections to surgical debridement or repair.

Stem cell therapy is a minimally invasive regenerative treatment that is being used to treat shoulder pain with minimal downtime.

NECK AND BACK PAIN

Neck and back pain is extremely common condition affecting 80% people at some point in their life.

Most people with back or neck pain improve over time with first line conservative treatment like stretching, exercise, physical therapy, chiropractor manipulation, along with taking over the counter Anti-inflammatory medications.

Next step is trying Epidural steroid injections if they failed conservative treatment and continue to experience neck, or back pain. Many a times Epidural injections doesn’t help or only provide short lived relief especially you are having Degenerative disc disease.

Every year, millions of people with back injuries, neck injuries, and pain undergo extensive spine surgeries. Frequently, surgery does not give you outcome you planned to achieve, and they are left with other painful conditions such as reduced back motion, diminished activity levels, and chronic muscle spasms related to scar tissue from surgery. There are numerous causes of back and neck pain, please consult with our physician to see what treatment option is appropriate for your condition.

Bone marrow derived stem cell therapy offers an exciting option for relief from debilitating back pain. Avoid surgery and pain medications with this minimally-invasive treatment.

HIP INJURIES AND PAIN

Hip pain is also very common condition affecting many of us. Thorough history and location of pain gives some clues about possible causes of hip pain.

Among many causes of hip pain, following causes of hip pain can be successfully targeted through Stem cell therapy Articular cartilage injury, Labral tears, Osteoarthritis.

Bone marrow derived stem cell therapy offers an exciting option for relief from debilitating hip pain. Avoid surgery and pain medications with this minimally-invasive treatment.

KNEE INJURIES AND PAIN

Every year, millions of people with knee pain undergo painful and expensive total knee replacement surgeries. Frequently, surgery does give you outcome which you planned to achieve, and they are left with other chronic pain conditions and get subjected to repeated surgical replacements.

As with any other body pain, there are numerous causes of knee pain. Currently these are few causes of knee pain which can be successfully targeted with Stem cell therapy.

• Torn Meniscus
• Anterior cruciate Ligament (ACL) injury
• Osteoarthritis

Many people get repeated Steroid injections in their knee joint in order to function with reduced pain, frequent steroid injections can be toxic to your knee cartilage.

Bone marrow derived stem cell therapy offers an exciting option for relief from debilitating knee pain. Avoid surgery and pain medications with this minimally-invasive treatment.

Regenerative cell therapies are simpler and much less invasive than surgical procedures.

Review: We will review your history of illness and injuries, including X-rays and MRIs. This will help the physician in determining whether an adult stem cell or PRP therapy will provide benefit to you.

Anything that could affect or alter the success of regenerative therapy will be evaluated by our physician
before regenerative therapies are planned. Since every patient is different, there are no guarantees that the medical treatment will result in the same clinical outcome for all.

Consult: If you are a good candidate for the procedure, you will meet the physician to review the procedure and to have any questions answered.

Prepare: You may be asked to stop any Anti-inflammatory medications like Ibuprofen, Alleve for a week before treatment which impedes the process of healing. We may ask you to consult with a Naturopath specialist to have a beneficial nutrition plan to follow before your procedure.

Procedure: With Image guided Injectable therapy, we deliver your own concentrated cells to help support and stimulate your body’s natural healing process. Stem cells are taken from an area of high concentration, like your hip bone, and delivered directly to the area of inflammation to help you heal naturally, safely, and in most cases, more quickly.

A typical adult stem cell procedure usually lasts about an 1 hour and consists of the following 3 steps

1. Using a syringe, the physician withdraws a small amount of bone marrow from an easy-to-access point on the hip of the patient using Image guidance.
2. The adult stem cells are separated from the rest of the bone marrow material.
3. The concentrated adult stem cells are returned to the part of the body that needs healing. 

Rest: You will be to advised to give rest to the treated area for 1 to 6 weeks, thereafter a personalized after care program optimal recovery and longterm results.. We will determine the method for follow-up which could be via phone, email, mail or post- treatment appointments.